SS-4262 (5/16)Business Services DivisionTre Hargett, Secretary of StateState of TennesseeINSTRUCTIONSAPPLICATION FOR ASSIGNMENT OF TRADEMARK OR SERVICE MARKSUBMISSION OPTIONSPaper submission, Walk-inApplications must be accurately completed in their entirety. Cover forms that are inaccurate, incomplete or illegible will be rejected.ASSIGNMENT INSTRUCTIONS þ APPLICANT INFORMATION1. þ Name of the mark: 2. þ Mark number: 3. þ The owner of record of the mark (assignor) is:4. þ The name of the new owner (assignee) is: American LegalNet, Inc. www.FormsWorkFlow.com 5. þ If the new owner (assignee) is a business entity, select the type of business entity: 6. þ If the new owner (assignee) is a business entity, the state of incorporation / organization is:7. þ If the new owner (assignee) is a partnership, the names of the general partners are:8. þ The executed assignment document is attached to this form. A photocopy of such a document may be of the originalSIGNATURE AND VERIFICATION225 þ Failure to sign the application will result in the application being rejected.Failure to type or print the signature name and title of the signer (if the assignor is a business entity) will result in the application being rejected.FILING FEE American LegalNet, Inc. www.FormsWorkFlow.com þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ APPLICATION FOR ASSIGNMENT OF TRADEMARK OR SERVICE MARK (SS-4262) Business Services DivisionTre Hargett, Secretary of StateState of Tennessee312 Rosa L. Parks Ave., 6th Fl.Nashville, TN 37243(615) 741-0531 In compliance with the requirements of T.C.A. 247 47-25-507, the undersigned hereby submits an assignment of a trademark or service mark registered in Tennessee:Filing Fee: $20.00 per class þ þ þ þ þ þ þ þ þ þ þ þ þ þ *Note: Pursuant to T.C.A. 247 10-7-503 all information on this form is public record. declare under penalty of perjury the foregoing statements are true and correct. þ þ þ þ þ þ ) þ American LegalNet, Inc. www.FormsWorkFlow.com